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This study sought to establish whether recent changes in discontinuation of contractive use and switching in Egypt can be considered an important cause of the unexpected increase in overall fertility and slight fall in contraceptive prevalence in the country. The analysis was based on calendar data from the 2008 and 2014 Egyptian DHS. Single/multiple decrement life tables were built to calculate contraceptive discontinuation rates and examine these by reasons for discontinuation focusing on three methods: IUDs, pills and injectables. The unit of the analysis was ‘segment of use’, defined as a continuous period of use/non-use of a contraceptive method (in months). It was found that over the period 2008–2014 the rise in the ‘all method’ discontinuation rate was mainly due to the shift away from IUDs to hormonal methods, which have higher discontinuation rates. Segments of use were more likely to be discontinued for ‘method/service-related’ reasons than for ‘reduced need’ reasons. This was due to an increase in contraceptive failure and side-effect/health concerns. Also, ‘the desire to get pregnant’ increased to become the second highest reason-specific discontinuation rate. This has coincided with a recent increase in ideal family size in Egypt. About half of the women who reported discontinuing for reasons related to method/services switched to another method, while the rest became subject to the risk of an unintended pregnancy. The rate of switching, rather than stopping use, increased for IUDs, remained the same for pills and increased slightly for injectables, indicating an improvement in switching behaviour. However, a marked high percentage of switchers moved to less-effective methods. If these issues are not addressed, many women in Egypt have an unmet need for contraception, leading to an increase in unintended pregnancies. Specific interventions that would greatly benefit the family planning programme in Egypt include improvement in counselling at the time of IUD insertion and removal and the reduction in failure rates for hormonal methods.
Solea aegyptiaca (Chabanaud, 1927) is one of the most common Soleid species in southern Tunisian waters. This study provides the first detailed information on the reproduction biology of S. aegyptiaca in these areas. Samples of S. aegyptiaca were collected by trawl from the Gulf of Gabes (Tunisia) between April 2013 and March 2015. A total of 1638 specimens were examined, ranging from 9.7 to 30.7 cm total length. The sex ratio was in favour of males in smaller size classes and females in larger size classes. The macroscopic analysis of the gonads and the progression of the monthly values of the gonadosomatic index (GSI) indicated that the reproductive season extended from October to February, with GSI peaking in November and December for males and females respectively, and that spawning occurs once a year from November to February. The utilization of lipid reserves, stored predominantly in the liver as well as in muscles, was depicted. The estimated average length at first maturity was 22.31 ± 0.41 cm for males and 23.19 ± 0.184 cm for females. Total fecundity of mature females ranged from 14,160–62,700 eggs per fish, showing a significant increase with size, with an average of 33,020 ± 5239 eggs per fish.
As part of a larger clinical trial concerning the use of transcranial magnetic stimulation (TMS) for treatment-resistant depression, the current study aimed to examine referral emails to describe the clinical characteristics of people who self-refer and explore the reasons for self-referral for TMS treatment. We used content analysis to explore these characteristics and thematic analysis to explore the reasons for self-referral.
Of the 98 referrals, 57 (58%) were for women. Depressive disorder was the most commonly cited diagnosis, followed by bipolar affective disorder. Six themes emerged from the thematic analysis: treatment resistance, side-effects of other treatments, desperation for relief, proactively seeking information, long-term illness and illness getting worse.
TMS has recently been recommended in the UK for routine use in clinical practice. Therefore, the number of people who self-refer for TMS treatment is likely to increase as its availability increases.
The downfall of the Soviet Bloc in the early 1990s led to an atmosphere of exaggerated victory, notably captured in Francis Fukuyama's famous book, The End of History, which celebrated the ideological triumph of democracy as a unanimously agreed-upon ideal form of government. The international law literature was not immune from the sense of democratic rejoicing. Of special note in this regard was the notion of an entitlement to democracy, introduced by the late Thomas Franck. Drawing on ideas of self-determination in international law, which themselves date back to the American Declaration of Independence, Franck postulated an “emerging right to democratic governance.” He stipulated that “[s]elf-determination postulates the right of a people organised in an established territory to determine its collective political destiny in a democratic fashion and is therefore at the core of the democratic entitlement.” This essay considers Franck's claims, and argues that his view of democracy was too thin; instead, the essay argues for an instrumental conception of democracy that ties it to other rights and entitlements.
From antiquity to the end of the twentieth century, philosophical discussions of understanding remained undeveloped, guided by a 'received view' that takes understanding to be nothing more than knowledge of an explanation. More recently, however, this received view has been criticized, and bold new philosophical proposals about understanding have emerged in its place. In this book, Kareem Khalifa argues that the received view should be revised but not abandoned. In doing so, he clarifies and answers the most central questions in this burgeoning field of philosophical research: what kinds of cognitive abilities are involved in understanding? What is the relationship between the understanding that explanations provide and the understanding that experts have of broader subject matters? Can there be understanding without explanation? How can one understand something on the basis of falsehoods? Is understanding a species of knowledge? What is the value of understanding?
Empathy is a multi-dimensional concept with affective and cognitive components, the latter often referred to as Theory of Mind (ToM). Impaired empathy is prevalent in people with neuropsychiatric disorders, such as personality disorder, psychopathy, and schizophrenia, highlighting the need to develop therapeutic interventions to address this. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive therapeutic technique that has been effective in treating various neuropsychiatric conditions, can be potentially used to modulate empathy. To our knowledge, no systematic reviews or meta-analyses in this field have been conducted. The aim of the current study was to review the literature on the use of rTMS to modulate empathy in adults. Seven electronic databases (AMED, Cochrane library, EMBASE, Medline, Pubmed, PsycInfo, and Web of Science) were searched using appropriate search terms. Twenty-two studies were identified, all bar one study involved interventions in healthy rather than clinical populations, and 18 of them, providing results for 24 trials, were included in the meta-analyses. Results showed an overall small, but statistically significant, effect in favour of active rTMS in healthy individuals. Differential effects across cognitive and affective ToM were evident. Subgroup analyses for cognitive ToM revealed significant effect sizes on excitatory rTMS, offline paradigms, and non-randomised design trials. Subgroup analyses for affective ToM revealed significant effect sizes on excitatory rTMS, offline paradigms, and non-randomised design trials. Meta-regression revealed no significant sources of heterogeneity. In conclusion, rTMS may have discernible effects on different components of empathy. Further research is required to examine the effects of rTMS on empathy in clinical and non-clinical populations, using appropriate empathy tasks and rTMS protocols.